Back Pain: When to See a Urologist or Rheumatologist - Urology

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When it comes to understanding back pain, especially in the context of a history of ankylosing spondylitis (AS), it's essential to approach the situation with a comprehensive perspective. Your symptoms, particularly the pain in the left side of your lower back and near the bladder that improves after urination, suggest a multifaceted issue that may involve both musculoskeletal and possibly urological factors.

Ankylosing spondylitis is a type of inflammatory arthritis that primarily affects the spine and can lead to severe, chronic pain and discomfort. It is characterized by inflammation of the vertebrae, which can result in chronic pain and stiffness in the back. Patients often experience increased pain during periods of inactivity, such as sleeping, and may find relief with movement. However, your recent symptoms, particularly the pain that seems to correlate with bladder function, raise additional considerations.

Given your history of AS and the new onset of pain that seems to be associated with urination, it would be prudent to consult both a rheumatologist and a urologist. Here’s why:
1. Rheumatologist: Since you have a history of ankylosing spondylitis, a rheumatologist is crucial in evaluating whether your current symptoms are related to the progression of AS or if they indicate a new inflammatory process. They can assess your spinal health through physical examinations and imaging studies, and they can also evaluate your blood tests for inflammatory markers that may indicate an exacerbation of your condition.

2. Urologist: The pain you describe near the bladder could suggest a urological issue, such as a urinary tract infection (UTI), kidney stones, or other bladder-related conditions. Even though your recent urine tests came back normal, it’s possible for urological issues to present with intermittent symptoms. A urologist can perform further evaluations, including imaging studies or cystoscopy, to rule out any underlying conditions that may be contributing to your pain.

In addition to these specialists, it may also be beneficial to consider physical therapy as part of your management plan. Physical therapy can help improve mobility, strengthen the muscles around your spine, and alleviate some of the discomfort associated with AS. A physical therapist can also provide you with exercises tailored to your specific needs and help you develop strategies to manage pain.

Moreover, it’s important to maintain open communication with your healthcare providers. If your symptoms change or worsen, or if you experience new symptoms such as fever, changes in urination, or significant changes in your back pain, you should seek medical attention promptly.
In summary, given your history of ankylosing spondylitis and the new symptoms you are experiencing, it would be wise to consult both a rheumatologist and a urologist. This dual approach will ensure that both potential musculoskeletal and urological issues are thoroughly evaluated, leading to a more accurate diagnosis and effective treatment plan. Remember, managing chronic conditions often requires a multidisciplinary approach, and staying proactive about your health is key to improving your quality of life.